Provider Demographics
NPI:1285951483
Name:MAYNARD, JEAN (LPN)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 GEERT CT
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3747
Mailing Address - Country:US
Mailing Address - Phone:571-507-0326
Mailing Address - Fax:
Practice Address - Street 1:2718 GEERT CT
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3747
Practice Address - Country:US
Practice Address - Phone:571-507-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider